Kallie Rose Breneman, OT
Individual provider Active NPI Occupational Therapist · Spanaway, WA
NPI 1831775642 · NPPES record last updated Mar 22, 2021
Key facts
- NPI
- 1831775642
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT61146343 (WA)
- Practice address
- 19321 Mountain Hwy E Ste 100
Spanaway, WA 98387-8450 - Phone
- (253) 846-8918
- NPI assigned
- Mar 22, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Multicare Health System
Practice addresses (Care Compare)
19321 Mountain Hwy E
Suite 100
Spanaway, WA 98387-8450
Phone (253) 846-8918
222 State Ave N
Kent, WA 98030-4544
Phone (253) 372-7788
311 S L St
Tacoma, WA 98405-3720
4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210422000444 | WA | Practitioner - Occupational Therapist in Private Practice | 1456769942 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Multicare Health System | Current |
Accepting new patients | |
| Multicare Health System | Current |
Accepting new patients | |
| Multicare Health System | Current | Accepting new patients | |
| Multicare Health System | Occupational Therapist | Past |
Accepting new patients |
Locations
4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590
222 State Ave N
Kent, WA 98030
Phone (253) 372-7680
19321 Mountain Hwy E
Ste 100
Spanaway, WA 98387
Phone (253) 846-8618
311 S L St
Tacoma, WA 98405
Phone (253) 403-1444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT61146343 | WA | Yes |
Addresses
Primary practice location
19321 Mountain Hwy E Ste 100
Spanaway, WA 98387-8450
Mailing address
6050 Tacoma Mall Blvd Ste 300
Tacoma, WA 98409-6828
Phone (253) 581-5200
Other providers in Spanaway, WA
- Jackelina Bonds
- Sandra Boyer
- Ivanna Boyko
- Julia Alayne Bradford
- Krisula Maria Brady
- Karla Ivonne Briceno
- Jazmin Brito
- Anders Brown
- Jonathan Brown
- Maryann Ruth Bulldis
All providers in Spanaway, WA · Occupational Therapist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.